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Foot and ankle

Foot and ankle. Common injuries. Squeamish?. Roll/twisted ankle: http:// www.youtube.com/watch?v=lgNttdd7UIc Breaking ankle: http:// www.youtube.com/watch?v=vA5BU045gi4. Bones. S&S Pain Decreased ROM Swelling Bruising NWB Obvious deformity. Bones. Any bone Acute fx Stress fx

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Foot and ankle

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  1. Foot and ankle Common injuries

  2. Squeamish? • Roll/twisted ankle: • http://www.youtube.com/watch?v=lgNttdd7UIc • Breaking ankle: • http://www.youtube.com/watch?v=vA5BU045gi4

  3. Bones • S&S • Pain • Decreased ROM • Swelling • Bruising • NWB • Obvious deformity

  4. Bones • Any bone • Acute fx • Stress fx • Avulsion fx • Jones Fx • Fx of the styloid process of the 5th Metatarsal • Union vs non-union • Knock-Off Fx

  5. Ligaments/Tendons • Ligament: bone to bone • Tendon: muscle to bone • Grading system: • 1+/-: stretched, but no tearing/fraying of fibers • 2+/-: tearing, but incomplete • 3: complete tear

  6. Cont’d • Signs & Symptoms: • Pain • Swelling • Decreased ROM • Increased temp of skin • Bruising • NWB • + laxity test

  7. Cont’d • ATFL– Candy if you can name it! • Most commonly sprained • MOI – “rolling ankle”, stepping in hole • Deltoid Ligament • Keep ankle from evertion; stronger than ATF • MOI – Stepping in hole • High Ankle Sprain – Syndesmotic Sprain • MOI - Dorsiflexion and evertion • Achilles Tendon • More commonly torn with age • MOI – Forced Dorsiflexion with knee bent

  8. Muscles • Strain • Grade 1, 2, 3 • Common muscles affected: • Peroneals • Calf

  9. “shin Splints” • Medial tibial stress syndrome (MTSS) • Caused by: • Irritated and swollen muscles, often from overuse • Stress fractures, which are tiny breaks in the lower leg bones • Overpronation or ''flat feet" -- when the impact of a step makes your foot's arch collapses • Runners might get them after ramping up their workout intensity, or changing the surface they run on

  10. Treatment: • Rest your body. It needs time to heal. • Ice your shin to ease pain and swelling. Do it for 2mins every 3 to 4 hours for 2 to 3 days, or until the pain is gone. • Anti-inflammatory painkillers. NSAIDs • Arch supports for your shoes. These orthotics -- which can be custom-made or bought off the shelf -- may help with flat feet. • Range-of-motion exercises • Neoprene sleevefor support. • Physical therapy to strengthen the muscles in your shins.

  11. You know it’s healed when.. • Your injured leg is as flexible as your other leg. • Your injured leg feels as strong as your other leg. • Your can jog, sprint, and jump without pain. • Your X-rays are normal or show any stress fractures have healed. • There's no way to say exactly when your shin splints will go away. It depends on what's causing them. People also heal at different rates; 3 to 6 months is not unusual.

  12. Diagnosis Process • HOPS: • History • Observation • Palpation – Provides a reference for the comparison of bilateral symmetry of bones, alignment, tissue temperature, or other deformity as well as the presence of increased tendernesss • Joint and Muscle Functional Assessment – impairment due to ROM, Strength, P with movement • Joint Stability Tests – reference for laxity, gapping, hypo/hypermobility, end-feel • Special Test

  13. Manual Muscle Testing • Patient position: Muscle tested must be against gravity • Examiner position: stabilize proximal to the joint being tested and provide resistance to the distal joint • “Break test” • Positive test: weakness and/or pain compared contralateral

  14. Grading • 5/5 Normal: can resist max pressure with no pain • 4/5 Good: can resist moderate pressure • 3/5 Fair: Can move body part against gravity thru full ROM • 2/5 poor: Can move body part in gravity-eliminated position thru full ROM • 1/5 Trace: cannot produce movement, but muscle contraction is palpable • 0/5 Zero: No contraction is felt

  15. End-Feel (Normal) • Soft: soft tissue approximation ex: knee flexion • Firm: Muscular stretch/Capsular Stretch/Ligamentous Stretch ex: Hip flexion, Ext of MCP joints in fingers, forearm supination • Hard: bone to bone ex: Elbow ext

  16. End-feel (pathological) • Soft: occurs sooner or later in ROM than normal in a joint that normally has a firm or hard end-feel ex: edema/synovitis • Firm: occurs sooner or later in ROM than normal in a joint that normally has soft or hard end-feel ex: Capsular/muscular/ligamentous shortening • Hard: occurs sooner or later in ROM than normal in a joint that normally has soft or firm end-feel; feels like a bony block ex: Loose bodies in joint/myositis ossificans/fx • Spams: Joint motion is stopped involuntarily or voluntary muscle spasm ex: inflammation/strain/joint instability • Empty: no end-feel bc end of ROM is never reached due to pain; no resistance felt except for patient’s protective muscle splinting or muscle spams ex: fx/brusitis/abscess

  17. Homework • Pages 4 and 5 in coloring packet

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